A rare cause and an even rarer treatment of hypertension in a 5-year-old boy: Mid-aortic syndrome.

Renal artery stenosis is one of the common vascular diseases that cause hypertension in children. However, renal artery aneurysms and abdominal aortic aneurysms, which may be components of mid-aortic syndrome, are rarely associated with renal artery stenosis. Despite its rarity, early diagnosis and treatment are critical to prevent fatal complications. Currently, non-surgical invasive techniques are considered the first choice for treatment, but in some cases, surgery is inevitable. Here, we present a 5-year-old boy with a mid-aortic syndrome. The patient presented with a history of severe headache and epistaxis 5-6 times a day and was diagnosed with hypertension. A 9 × 9 mm saccular aneurysm on the anterior surface of the abdominal aorta at the level of the left renal artery ostium, and a 12 mm aneurysm in the left renal artery after a stenotic segment at the hilum level was detected in the doppler USG and contrast-enhanced imaging techniques. The patient was operated on electively. We used a PTFE patch to repair the abdominal aorta and, saphenous vein which was taken from his father to repair the renal artery. The patient recovered well and was discharged on the 18th day.

Cystic echinococcosis of the interventricular septum: a rare clinical presentation.

Cystic echinococcosis caused by infection with the larvae form of Echinococcus granulosus remains highly endemic and constitutes a public health concern in some regions of the world. In this case report, we present a rare children case of interventricular hydatid cyst with a size of approximately 5 cm and its successful treatment.

The effect of neutrophil-lymphocyte ratio on the postoperative course of coronary artery bypass graft surgery

Background/aim: Recovery after coronary artery bypass graft surgery (CABG) can be complicated, leading to postoperative morbidity. The roles of hematologic and surgery-related parameters are important. The main purpose of this study is to determine the role of preoperative and postcardiopulmonary bypass neutrophil/lymphocyte ratio (NLR) on postoperative recovery. Materials and methods: Sixty-two patients aged between 41 and 80 years, scheduled for elective CABG surgery with ASA I-II risk and without a history of preoperative blood transfusion, were included in the study. Three patients were excluded due to their need for additional surgical procedures other than CABG. The patients were divided into two groups that were formed depending on preoperative NLR cut-off values below (Group 1, n = 37) and above 4 (Group 2, n = 22). Postoperative data such as length of stay in the hospital and in the intensive care unit (ICU), chest tube drainage, and incidence of atrial fibrillation were recorded for all patients. Results: Preoperative NLR was significantly lower in Group 1 (P < 0.0001), and there was no significant difference between the groups in terms of postoperative NLR (P = 0.217) when the two groups were compared. The patients in Group 2 had a longer length of stay in the ICU (P = 0.035) and in the hospital (P = 0.034). There was a positive correlation between preoperative NLR and length of stay in the ICU (P = 0.017) and the hospital (P = 0.014). No statistically significant differences in postoperative drainage or incidence of postoperative atrial fibrillation were detected between the two groups. Conclusion: The results of our study demonstrate that the postoperative NLR may be useful to predict the length of hospital and ICU stays and help the management of follow-up and treatment processes in patients undergoing CABG surgery.

The effects of iloprost on ischemia-reperfusion injury in skeletal muscles in a rodent model.

PURPOSE: The aim of this study was to investigate the effects of iloprost (IL) on ischemia-reperfusion injury in a rodent model. MATERIALS AND METHODS: Twenty-four Wistar Albino rats were randomized into four groups (n = 6). Laparotomy was performed in all groups under general anesthesia. Only laparotomy was applied in group S (Sham). Ischemia-reperfusion group (group I/R) underwent ischemia and reperfusion performed by clamping and declamping of the infrarenal abdominal aorta for 120 min. The iloprost group (group IL) received intravenous infusion of IL 0.5 ng/kg/min, without I/R. Group I/R + IL received intravenous infusion of IL 0.5 ng/kg/min immediately after 2 h period of ischemia. At the end of the reperfusion period, all rats were killed under anesthesia and skeletal muscle samples of lower extremity were harvested for biochemical and histopathologic analyses. RESULTS: Tissue levels of endothelial nitric oxide were significantly higher in I/R groups than those in groups S and IL. The heat shock protein 60 levels were higher in group I/R than the other groups. But the heat shock protein 60 levels in group I/R + IL were found to be similar with the groups S and IL. Malondialdehyde levels were significantly higher in group I/R. On the other hand, in group I/R + IL, malondialdehyde levels were higher than those in groups S and IL but lower than those in group I/R. Superoxide dismutase (SOD) enzyme activities were found to be significantly lower in group I/R than the other groups. Also in group I/R/I, the SOD enzyme activities were higher than those in group I/R. But, in group I/R + IL, SOD levels were found to be higher than those in group I/R but lower than those in groups S and IL. CONCLUSIONS: These results indicate that IL has protective effects on I/R injury in skeletal muscle in a rodent model.

Comparing S-100 beta protein levels and neurocognitive functions between patients undergoing on-pump and off-pump coronary artery bypass grafting.

BACKGROUND: In the present study, we aimed to investigate the effects of off-pump coronary artery bypass grafting and on-pump cardiopulmonary bypass on the serum S-100 beta (S-100B) protein levels and neurocognitive functions of the patients. MATERIALS AND METHODS: Sixty-four patients undergoing coronary artery bypass grafting (CABG) were enrolled in the study and were divided into two groups: off-pump (group I, n = 24) and on-pump CABG (group II, n = 40) group. Serum S-100B levels were measured before and 0, 6, and 24 h after the operation. Neurocognitive function tests were done preoperatively and were repeated in the postoperative period as well. RESULTS: Serum S-100B levels were similar between the two groups preoperatively. However, median S-100B levels at 0, 6, and 24 h after the surgery were found to be significantly lower in the off-pump CABG group than in the on-pump group. The preoperative neurocognitive functions of the patients were similar between the two groups, whereas neurocognitive function was found to be significantly impaired postoperatively in the on-pump group in comparison with the off-pump CABG group. CONCLUSION: We concluded that off-pump CABG is associated with decreased serum S100 protein levels and less impairment on neurocognitive functions compared with the on-pump group.

Differential identification of atypical pneumonia pathogens in aorta and internal mammary artery related to ankle brachial index and walking distance.

BACKGROUND: We studied the existence of agents in aorta biopsies, such as Chlamydia pneumoniae, cytomegalovirus, and Mycoplasma pneumoniae, that are thought to have a role in atherosclerosis etiopathogenesis role, and their association with peripheral artery disease. MATERIALS AND METHODS: We examined aorta wall and internal mammarian artery (IMA) biopsies taken from two different places in 63 patients in whom coronary artery bypass was performed. In these biopsies, we evaluated the deoxyribonuclease (DNA) of these microorganisms using polymerase chain reaction. From the same patients, we recorded the ankle brachial index, road walking distance information, lipid profile, C-reactive proteins, blood parameters such as fibrinogen, and the patient's operation data. RESULTS: In the nine aorta biopsies taken from 63 patients, we isolated C pneumoniae DNA. In IMA biopsies taken from the same patients, we detected no microorganism DNA (P < 0.001). In the same aorta biopsies, we found no cytomegalovirus or M pneumoniae DNA. We examined 12 patients using an index value of 0.9 in the ankle brachial index evaluation; eight had C pneumoniae in the aorta biopsies (P < 0.001). CONCLUSIONS: We found a significant relationship between C pneumoniae DNA and the existence of peripheral artery disease. In the development of atherosclerosis with C pneumoniae, there may be a determinant pathogen in both the aorta and the peripheral arteries. The nonexistence of C pneumoniae DNA in the IMA biopsies may indicate infectious agents because of the predominant endothelial functions in this artery, and thus its resistance to atherosclerosis.

Effects of lidocaine on membrane stabilization in harvested vein graft storage.

OBJECTIVE: To investigate the effects of lidocaine on the morphology of saphenous veins (SVs) harvested during coronary artery bypass graft (CABG) surgery. METHODS: This experimental study was conducted at the Cardiovascular Surgery Department, Gazi University, Ankara, Turkey, between May and September 2007. The SVs from 11 patients who underwent CABG surgery were divided into 3 segments. Each segment from the same location of the grafts was allocated into 3 groups as control group (group C), physiologic saline group (group PS), and lidocaine group (group L). Nitric oxide synthase (NOS), nitric oxide (NO) pool, super oxide dismutase (SOD), and thiobarbituric acid reactive substances (TBARS) levels were measured in the samples from the groups. Histologic specimens were evaluated according to previously defined criteria, and scored accordingly. RESULTS: Histological examination of the grafts in groups L and C were similar, but histological scoring of grafts in group PS were statistically higher than group C (p=0.008). Nitric oxide synthase activity and NO pool were higher in groups L and PS than in group C (p=0.010). Super oxide dismutase activity was higher in group L than in group PS (p=0.008). Super oxide dismutase activity was lower in group PS than in group C (p=0.047). There was no significant difference between TBARS level in all groups. CONCLUSION: Our results indicate that primary damage might occur during surgery due to traumatic handling of the graft, and succeeding injuries could occur due to ischemia-reperfusion injury during the waiting period. Adding lidocaine to the preservation solution will protect later injury.

Removal of a retained intracardiac guidewire fragment reaching out to subcutaneous tissue of thoracic wall in a pediatric patient.

The use of vascular access lines in both central venous and arterial sites has significantly increased over the past decades. A retained intravascular foreign body is a well-known complication of central venous catheter placement in children as well as in adults. Herein, we present our experience of surgical removal of a retained intracardiac guidewire fragment penetrating into the subcutaneous tissue of the thoracic wall in a pediatric case.

Detection of Helicobacter pylori DNA in aortic and left internal mammary artery biopsies.

We investigated the relationship between acute coronary ischemia and the presence of Helicobacter pylori DNA in aortic regions that were absent macroscopic atheromatous plaques. The study group (Group 1) consisted of 42 patients who underwent coronary artery bypass grafting. Biopsy samples were obtained from 2 different locations: from regions of the aorta that were free (macroscopically) of atheromatous plaque (Group 1A), and from the internal mammary artery (Group 1B). The control group (Group 2) of 10 patients who had no atherosclerotic vascular disease provided aortic tissue samples for comparison. The real-time polymerase chain reaction method was used to detect H. pylori DNA in all biopsy samples. Eleven of 42 aortic tissue samples (26%) in Group 1A were positive for H. pylori DNA. Neither biopsies from the left internal mammary arteries of those patients nor biopsies from the aortas of the control group (Group 2) were positive for H. pylori DNA. There was a statistically significant difference between 1A and 1B in terms of H. pylori positivity (P=0.001). In Group 1 as a whole, acute coronary ischemia was more prevalent in the H. pylori-positive patients than in the H. pylori-negative patients (P=0.001). To our knowledge, this is the 1st study to investigate the detection of H. pylori DNA in aortic biopsy samples that are macroscopically free of atheromatous plaque. Such detection in patients who have atherosclerotic coronary artery disease could be an important indication of the role of microorganisms in the pathogenesis of atherosclerosis.

Effects of atypical pneumonia agents on progression of atherosclerosis and acute coronary syndrome.

BACKGROUND: The aim of this study was to investigate the presence of various atypical pneumonia agents (Chlamydia pneumoniae, cytomegalovirus, Mycoplasma pneumoniae), which are considered to have a role in the ethiopathogenesis of atherosclerosis, in aortic biopsies without macroscopically visible plaque and in internal thoracic artery biopsies. MATERIAL AND METHODS: Thirty-three patients (group 1), who had undergone coronary bypass operation and 10 non-atherosclerotic patients (group 2), were included in the study. Seventy-six tissue biopsies were taken. Biopsies from the patients in group 1 a were obtained from the atheroma plaque-free aortic tissue and 33 biopsies (group Ib) were obtained from their internal thoracic arteries. Following DNA extraction, nested PCR was used to detect Chlamydia pneumoniae DNA, and real time PCR was used to detect cytomegalovirus and Mycoplasma pneumoniae DNA. Blood parameters (lipid profile, CRP, fibrinogen) of the patients and operation characteristics were recorded. RESULTS: Chlamydia pneumoniae DNA was detected in 5 of 33 biopsy samples from coronary bypass patients, whereas none of the control patients (group 1b and group 2) were positive for this agent (P = 0.001). Neither CMV nor Mycoplasma pneumoniae was detected in IMA and aortic biopsies of both bypass and control patients. Elevated total cholesterol levels (P = 0.02) and positive CRP (P = 0.001) was found in C. pneumoniae positive patients. Prevalence of acute coronary syndrome was significantly higher in C. pneumoniae detected patients compared (P = 0.00 1). CONCLUSIONS: Detection of C. pneumoniae DNA in the atheroma free aortic biopsies might indicate that this micro-organism intervened in the progression of atheroma plaque. There was a strong relationship between the detection of this micro-organism in the aortic wall and acute coronary syndrome. The absence of DNA of the corresponding micro-organisms in the IMA wall may show its resistance to infective agents and in turn to atherosclerosis, which is a result of the prevailing endothelial functions of this artery.

Free intra-abdominal hemorrhage after open-heart surgery: an unusual gastrointestinal complication.

Gastrointestinal complications after open-heart surgery are rare. Many preoperative, intraoperative, and postoperative factors may predispose patients to these complications or cause them. Our patient was a 64-year-old woman who underwent aortic valve replacement due to aortic stenosis. Free intra-abdominal hemorrhage occurred on the 2nd postoperative day. During exploratory laparotomy, it was determined that the hemorrhage was from a vein near the falciform ligament of the liver and from a bleeding laceration of the splenic capsule. The complication was repaired surgically. To our knowledge, intra-abdominal hemorrhage of both liver and spleen after open-heart surgery has never been reported before, even in large patient series. We report the case and present our ideas regarding the cause of the bleeding.

Protective effect of aprotinin against lung damage in patients undergoing CABG surgery.

OBJECTIVE: We investigated the protective effects of aprotinin, administered in the pulmonary artery, on lung damage after cardiopulmonary bypass (CPB). METHODS: A total of 20 patients undergoing elective coronary artery bypass grafting operations was included in the study and divided into two groups. In the aprotinin group (study group) (n = 10) the drug was administered in the pulmonary artery (15,000 KIU/min) via the pulmonary artery catheter. The control group (n = 10) received only placebo. Blood gas measurements, respiratory function tests, malondialdehyde (MDA), nitric oxide (NO), C4 and leukocyte counts were determined as parameters. Blood samples were taken before and after cross clamping. Lung biopsies were taken before and after CPB. RESULTS: In the aprotinin group, forced expiratory volume (FEV1) and paCO2 values were better than in the control group. The postclamping MDA value in the study group was 20.6 +/- 8.7 etamol/ml and in the control group 37.5 +/- 9.6 etamol/ ml. The post clamping NO value in the study group was 261.9 micromol/l and in the control group 147.20 +/- 27.6 micromol/l. C4 levels were found to be better in the study group than in the control group: reduced levels of C4 were found to be statistically significant (study group postclamping: 12.98 +/- 2.63 mg/dl vs. control group 20.6 +/- 11.81 mg/dl). The increase in leukocyte count was found to be statistically significant (12.63 +/- 3.83 x 10(3) vs. 7.27 +/- 1.72 x 10(3). The difference between the preoperative and postoperative FEV1 in the control group was statistically significant. A statistically significant difference was found in the postoperative FEV1 in both groups. CONCLUSION: Aprotinin administered in the pulmonary artery during CPB had a protective effect against lung damage after open-heart surgery.

Bacterial endocarditis of systemic atrioventricular valve (tricuspid valve) in corrected transposition and its surgical treatment.

We describe a case of congenitally corrected transposition of great arteries (CCTGA). Tricuspid valve replacement was performed due to valve dysfunction following bacterial endocarditis. After two weeks' antibiotic therapy haemodynamic stabilisation was obtained and the patient was operated in the third week. On cardiopulmonary bypass with 28 degrees C degree systemic hypothermia, the left atrium was approached transeptally. At exploration, the systemic atrioventricular valve was tricuspid valve and pulmonary atrioventricular valve was in shape of a mitral valve. The posterior leaflet of the tricuspid valve was ruptured and vegetations above it were observed. The valve was excised and a 29 mm St-Jude mechanical heart valve prosthesis implanted using a teflon reinforced separated suture technique. After operation the patient recovered rapidly and following six weeks' antibiotic therapy, the patient was discharged.

Retrospective assessment of vascular injuries: 23 years of experience.

PURPOSE: To analyze the operation methods, injury etiologies and localizations, post-operative complications and the reasons for mortality in patients who were admitted for peripheral vascular injuries to our clinics. METHODS: From January 1979 to February 2002, 410 patients were operated for peripheral vascular injuries. Three hundred and one of the patients were male (73.5%) and 109 of them were female (26.5%), and their ages ranged between 1-88 (mean 35.5 years). RESULTS: The most common etiological reason was firearm injuries in 163 patients (39.8%). The most common injured artery was the brachial artery (83 patients, 22.5%) among a total of 369 patients whereas the most commonly injured vein was the common femoral vein (60 patients, 23.4%) in a total of 256 patients. Isolated venous injuries were encountered in 41 patients whereas isolated arterial injuries were detected in 154 patients (37.5%). Hospital admission duration of the patients after trauma was approximately 3 hours. CONCLUSION: The extremity-salvage rate in the group was 92.3%. The hospital stay period of the patients was 21.8 days. The mortality rate was 2.6% (11 patients).

[The organ effects of systemic inflammation response activated during open heart surgery and current treatment methods]. / Açik Kalp Cerrahisi Esnasinda Aktive Olan Sistemik Inflamasyon Cevabinin Organ Fonksiyonlarina Etkileri ve Güncel Tedavi Yöntemleri.

Multi-organ failure may occur due to activation of systemic inflammatory process with many other factors in open-heart procedures when cardiopulmonary bypass is used. Activation of systemic inflammatory process may cause postoperative complications. Surgical trauma, contact of blood with foreign surface, endotoxemia and ischemia-reperfusion injury are major factors that contribute to activation of inflammatory response. In this review we purposed to investigate the factors which contribute to the systemic inflammatory process, multiorgan dysfunction and the therapeutic modalities during open heart surgery.